Inspection on 18/06/07 for Rosemary Lodge

This inspection was carried out on 18th June 2007.

CSCI has not published a star rating for this report, though using similar criteria we estimate that the report is Good. The way we rate inspection reports is consistent for all houses, though please be aware that this may be different from an official CSCI judgement.

The inspector found there to be outstanding requirements from the previous inspection report but made no statutory requirements on the home.

Other inspections for this house

Rosemary Lodge 29/11/06

Rosemary Lodge 24/02/06

Rosemary Lodge 26/08/05

Rosemary Lodge 23/11/04

Rosemary Lodge 14/04/04

Similar services:

Ashlong House

Henry Nihill House

Birchwood

The Infirmary

Orchard House Nursing Home

St Josephs Rest Home

Red Court Nursing Home

Spinney (The)

Extracts from inspection reports are licensed from CQC, this page was updated on 09/07/2008.

CARE HOMES FOR OLDER PEOPLE Rosemary Lodge 9 The Drive Wimbledon London SW20 8TG Lead Inspector Jean Stuart Unannounced Inspection 18th June 2007 10:00 X10015.doc Version 1.40 Page 1 The Commission for Social Care Inspection aims to: • • • • Put the people who use social care first Improve services and stamp out bad practice Be an expert voice on social care Practise what we preach in our own organisation Reader Information Document Purpose Author Audience Further copies from Copyright Inspection Report CSCI General Public 0870 240 7535 (telephone order line) This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. Extracts may not be used or reproduced without the express permission of CSCI www.csci.org.uk Internet address Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 2 This is a report of an inspection to assess whether services are meeting the needs of people who use them. The legal basis for conducting inspections is the Care Standards Act 2000 and the relevant National Minimum Standards for this establishment are those for Care Homes for Older People. They can be found at www.dh.gov.uk or obtained from The Stationery Office (TSO) PO Box 29, St Crispins, Duke Street, Norwich, NR3 1GN. Tel: 0870 600 5522. Online ordering: www.tso.co.uk/bookshop This report is a public document. Extracts may not be used or reproduced without the prior permission of the Commission for Social Care Inspection. Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 3 SERVICE INFORMATION Name of service Rosemary Lodge Address 9 The Drive Wimbledon London SW20 8TG Telephone number Fax number Email address Provider Web address Name of registered provider(s)/company (if applicable) Name of registered manager (if applicable) Type of registration No. of places registered (if applicable) 020 8946 6963 020 8296 0025 sdawson@wimbledonguild.co.uk The Wimbledon Guild Mrs Margaret Redway Care Home 44 Category(ies) of Dementia - over 65 years of age (4), Mental registration, with number Disorder, excluding learning disability or of places dementia - over 65 years of age (4), Old age, not falling within any other category (22), Physical disability (25) Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 4 SERVICE INFORMATION Conditions of registration: 1. The home can admit up to four named service users aged 50 years and over. 29th November 2006 Date of last inspection Brief Description of the Service: Rosemary Lodge is situated in a residential area of Wimbledon, close to local bus routes. The home is within a twenty-minute walk to Wimbledon Village. The home provides nursing and personal care for up to forty-seven older people. Rosemary Lodge is registered to provide care for up to four people with dementia and up to twenty-seven people who may have physical disabilities. The home is owned and managed by the Wimbledon Guild a registered charity. Accommodation is provided over three floors and includes a lounge, sun lounge, dining room, thirty-two single bedrooms and four shared bedrooms. Two passenger lifts serve each floor. Rosemary Lodge has access to a large level garden, which is mainly laid to lawn, with a paved area, pond, shrubs and trees. There is limited parking to the front of the home, however parking is also available on the street. Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 5 SUMMARY This is an overview of what the inspector found during the inspection. This unannounced inspection was carried out on the 18 June 07 by two inspectors, and took nine hours. The inspection included discussions with people living there, the manager and staff. Records were examined and the premise inspected. Fourteen survey forms were returned from residents/relatives People living at the home reported, “they look after me well”. Three G.P.s, a Physiotherapist and a Community Psychiatric Nurse providing services to Rosemary Lodge returned positive survey forms. The fees charged for the service is between £520.00 and £810.00 per week What the service does well: What has improved since the last inspection? Since the managers return from secondment the team has made a concentrated effort to improve the weak areas of the service. Survey forms returned from service users and their relatives showed the benefits of a named nurse and keyworker system. The system “helps my relative as they are now receiving continuity of care”. Assessments on peoples needs are fully completed. Care plans are individualised. Daily records reflect the actual care given. Activities are individualised and resident focused. A relative reported, “Activities arranged are excellent” Excess stocks of medication are no longer held. Clear directions are available for medication administration. Allergies are noted on medication sheets. Medication is signed for. Staff have attended refresher courses in safeguarding adults. Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 6 The menu has improved and provides varied and nutritious suppers. A relative commented that “During the last few months the quality of food has improved as fresh food is served at teatime”, a comment by a relative. The atmosphere in the lounge has improved by the television not being excessively loud and care being taken to choose suitable programmes. Staff files contain the required information and staff under go a thorough recruitment process prior to being employed. Staff now wear badges and are easily identifiable. Staff have seen improvements in the level of support offered by the manager. What they could do better: Please contact the provider for advice of actions taken in response to this inspection. The report of this inspection is available from enquiries@csci.gsi.gov.uk or by contacting your local CSCI office. The summary of this inspection report can be made available in other formats on request. Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 7 DETAILS OF INSPECTOR FINDINGS CONTENTS Choice of Home (Standards 1–6) Health and Personal Care (Standards 7-11) Daily Life and Social Activities (Standards 12-15) Complaints and Protection (Standards 16-18) Environment (Standards 19-26) Staffing (Standards 27-30) Management and Administration (Standards 31-38) Scoring of Outcomes Statutory Requirements Identified During the Inspection Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 8 Choice of Home The intended outcomes for Standards 1 – 6 are: 1. 2. 3. 4. 5. 6. Prospective service users have the information they need to make an informed choice about where to live. Each service user has a written contract/ statement of terms and conditions with the home. No service user moves into the home without having had his/her needs assessed and been assured that these will be met. Service users and their representatives know that the home they enter will meet their needs. Prospective service users and their relatives and friends have an opportunity to visit and assess the quality, facilities and suitability of the home. Service users assessed and referred solely for intermediate care are helped to maximise their independence and return home. The Commission considers Standards 3 and 6 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 1,2,3,4,5. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. Prospective users and their representatives have information required to help them choose a home. Residents have individual their needs assessed. A contract is drawn up for residents telling them about the service they will receive. EVIDENCE: The home has a Statement of Purpose outlining the facilities and services provided by the home. Further details are required with regard to staffing and the services given to people with dementia. The service users guide should set out what the prospective resident can expect. Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 9 One resident reported that they knew about Rosemary Lodge before they moved in. Satisfactory information is provided to prospective residents. This was supported by the positive returns on the resident/ relative survey forms. Preadmission visits are possible. Residents are assessed prior to admission to the home. Physical, social care and emotional needs are taken into account. Further attention is needed to detail relating to physical needs. It is not adequate to say a persons skin is intact. The condition of persons skin should be more precise, for example whether skin is dry, or thin will help the carer in the future. Care is taken to ensure that residents’ life history, their occupation, and social interests are noted. The care plan should include important dates in a person’s life. Sexuality is touched upon, it should also include significant relationships/partners in a resident’s life. A revised assessment form is now in use. Information is gathered from the resident and family members. In line with keyworking all qualified staff should complete assessments. Contracts detailing the service provision are drawn up for each resident and a copy held on file. Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 10 Health and Personal Care The intended outcomes for Standards 7 – 11 are: 7. 8. 9. 10. 11. The service user’s health, personal and social care needs are set out in an individual plan of care. Service users’ health care needs are fully met. Service users, where appropriate, are responsible for their own medication, and are protected by the home’s policies and procedures for dealing with medicines. Service users feel they are treated with respect and their right to privacy is upheld. Service users are assured that at the time of their death, staff will treat them and their family with care, sensitivity and respect. The Commission considers Standards 7, 8, 9 and 10 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 7,8,9,10. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. The home must ensure that residents health care needs when met are fully recorded. Evidence of the principals of respect and dignity were seen in the health and personal care that people receive. These principals were not maintained in all areas of a carers work. EVIDENCE: People have access to health care services both within the home and by visits from health care professionals. The returned survey forms from Health and Social care Professionals all agreed that “the home operates in the best Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 11 interests of the person”. The “cultural, ethnic or disability issues are being addressed”. It can be seen that care plans are individualised and contain specific details of how needs are to be met. Care plans lead from assessments, which are person centred. Personal care needs reflecting personal choice in bathing and frequency demonstrates respect for a residents’ personal choice. One resident’s dignity is upheld by always being well dressed. The care plans lack details concerning how inappropriate behaviour manifests and the interventions required to minimise this behaviour. Care plans have some gaps in written information but staff are able to give verbal updates on the care provided. Physical needs such as fluid intake were recorded appropriately. In other areas records were inadequate. It was not possible to track information with regard to continence assessments, the depression scale, hoists and slings to be used, and wound care. The home must ensure that service users health care needs are met and fully recorded. Daily recording showing details of how people’s needs are met, now reflect a much fuller picture of each persons’ day. Care must be taken to reflect residents activities or non-activity, in a positive manner. Medications are stored securely, the record showed that there are no issues with administration. Allergies are noted. Nurses signatures are difficult to read. A clear and legible record should be maintained. Survey forms showed medical support is always or usually available. A resident indicated that they would like to see an improvement in dental care. The home has policies and procedures, which provide guidance for staff on how to support a person, to provide good care these must be fully used. Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 12 Daily Life and Social Activities The intended outcomes for Standards 12 - 15 are: 12. 13. 14. 15. Service users find the lifestyle experienced in the home matches their expectations and preferences, and satisfies their social, cultural, religious and recreational interests and needs. Service users maintain contact with family/ friends/ representatives and the local community as they wish. Service users are helped to exercise choice and control over their lives. Service users receive a wholesome appealing balanced diet in pleasing surroundings at times convenient to them. The Commission considers all of the above key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 12,13,14,15. Quality in this outcome area is adequate. This judgement has been made using available evidence including a visit to this service. Residents are able to make social and cultural choices about their lives and have the opportunity to maintain family links. Maintance of daily living skills should be encouraged. A balanced diet is served, however the routine of serving food should be improved to promote individuals dignity. EVIDENCE: The home has sought the views of residents and considered their interests when planning the routines of daily living. The home promotes the individual’s right to live a meaningful life, and to be a part of the community. A resident’s enjoyment of music is enhaced by attending a musical meeting in the community. The manager reported that children from a local school visit and as shown in the daily record play dominos with residents. Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 13 A physiotherapist reported that she has been visiting the home for eighteen months and “many residents have made good progress and regained mobility and therefore dignity”. One relative spoke highly of the activities provided, another person stated “there is not enough mental stimulation for their degree of Alzheimer’s”. A Community Psychiatric Nurse reported that there is a “good daily activity session”. However an area for improvement is for carers to “spend more time sitting down with residents and talking with them, particually when they are restless or agitated”. The service is yet to enable residents to use their living skills and make informed choices. One resident stated that they would like to make their own cup of tea but is not allowed to. The possibility of this activity should be explored with the resident. Families have now set up their own group and feedback to the manager their views on the service. Residents eat in two areas. The menu is on the board in the dining room. The people in the dining room were able to share their opinion on the food served. One person said, “I enjoy this meal”. Residents with some confusion or those who have chosen not to sit at the dinning table, eat in the lounge. Residents sit around the edge of the room and the food is served on a small table in front of them. They are no apparent choice of meal or beverages. Meals were plated, and served with large measure of gravy. There were no condiments to flavour the meal to their taste. All residents had bibs placed on them, a napkin would be more age appropriate. Carers did not stay to assist one resident at a time but kept walking away to assist someone else. Carers discussed over the heads of residents how the workload was to be managed. One persons plate guard was broken, it took carers ten minutes to notice this. A resident clearly said they did not like the meal. The meal was sitting untouched in front of them. Other residents had finished their meal before anyone was available to assist this resident. The chef has spent time reviewing the menu and a wider range of food is now served. One relative reported that the meal is “home made and there is a good variety”, another person said that “the food has improved recently” my relative has the “food pureed and it is presented well in different items” Carers offered help and support to residents but failed to be sensitive to the person and other people using the service. The serving of the meal and the demands upon staff need urgent attention. Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 14 Complaints and Protection The intended outcomes for Standards 16 - 18 are: 16. 17. 18. Service users and their relatives and friends are confident that their complaints will be listened to, taken seriously and acted upon. Service users’ legal rights are protected. Service users are protected from abuse. The Commission considers Standards 16 and 18 the key standards to be. JUDGEMENT – we looked at outcomes for the following standard(s): Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The service has a complaints procedure that meets the minimum standards and Regulations. There is a Protection of Vulnerable Adults procedure in place. Residents are safe and secure. 16,18. EVIDENCE: Since the previous inspection the home has received five complaints. Two of which were found to be substantiated. A good process was followed in the investigation of these complaints. Staff have received training around Safeguarding adults and an understanding of how to put this into practice. The home aims to have an open culture that allows residents and their relatives to express their views. A relative group has been established to promote different peoples views of the service. Fourteen forms were returned from the residents/relatives. None had made a complaint, all knew how to complain. One person stated that “ the complaint process is too lengthy”. All reported that they would know who to speak to if Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 15 they were not happy. One person said “there should be a way to give people praise”. Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 16 Environment The intended outcomes for Standards 19 – 26 are: 19. 20. 21. 22. 23. 24. 25. 26. Service users live in a safe, well-maintained environment. Service users have access to safe and comfortable indoor and outdoor communal facilities. Service users have sufficient and suitable lavatories and washing facilities. Service users have the specialist equipment they require to maximise their independence. Service users’ own rooms suit their needs. Service users live in safe, comfortable bedrooms with their own possessions around them. Service users live in safe, comfortable surroundings. The home is clean, pleasant and hygienic. The Commission considers Standards 19 and 26 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 19,26. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The home has a well maintained environment, aids and equipment are provided to meet the care needs of residents. Where rooms are shared it is only by agreement and screens are provided for privacy. Residents are able to bring in small personal items and furniture with them, to make their rooms homely. EVIDENCE: A person reported that her relatives has “a lovely room, clean and comfortable”. The environment is well maintained, this was evidenced in a tour of the premises. Suitable equipment is available to make sure that residents Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 17 needs can be met. Some bedrooms are shared, screens are provided for privacy. Residents are encouraged to personalise their bedrooms. The atmosphere in the main lounge has improved by it not being dominated by the television, Glen Miller music was being played. Chairs are around the edge of the room, which is not a very homely arrangement. The Chief Executive of the Wimbledon Guild who own the home has plans for an extension to improve communal space. This would make access to the dining room better and allow more activities to take place. Survey forms reported that the home was always or usually clean and fresh. However “cleaning of residents rooms leaves a bit to be desired”. One relative stated “sometimes” the home is clean as their relative shares a room and sometimes due to “incontinence there is a smell”. Another person reported that there are “excessive use of spray polishes and fresheners” and reported that sometimes the home is clean. A stained bedroom carpet was indicated in a survey form. Another person said “Another person said there are “occasionally unavoidable smells which are dealt with efficiently”. Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 18 Staffing The intended outcomes for Standards 27 – 30 are: 27. 28. 29. 30. Service users’ needs are met by the numbers and skill mix of staff. Service users are in safe hands at all times. Service users are supported and protected by the home’s recruitment policy and practices. Staff are trained and competent to do their jobs. The Commission consider all the above are key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 27,28,29,30. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. There is enough qualified , competent and experienced staff to meet the health and welfare of the people using the service. Staffing rotas take into account the needs of routines of residents. Attention is needed to the effective deployment of staff at lunchtime. EVIDENCE: One person said my relative “is safe and well cared for”. Residents are supported by staff that have access to relevant training. The home has clear policies and procedures for staff recruitment. These are followed to make sure that all necessary checks are undertaken. Information contained in the staff files examined showed that Criminal Records Bureau checks were obtained. The employer shows that they have good understanding of equality and diversity throughout the recruitment, induction and training process. Positive remarks were made concerning staff on the survey forms returned. Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 19 One person said a particular staff member is “marvellous, very dedicated and observant, if they feel anything is wrong they will act immediately” Concerning another member of staff the comment was made that “they do a fantastic job”. Indeed the dignity of the individual is so well protected “one is not aware of the personal care that needs doing”. The survey forms showed that care staff were “always prepared to listen and act on what was said”, on another form “everyone is friendly and helpful”. A G.P. reported that “both senior and junior care staff know the patients, there is excellent knowledge of individual residents and their needs”. The physiotherapist that the “co-operation and enthusiasm I receive is excellent” Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 20 Management and Administration The intended outcomes for Standards 31 – 38 are: 31. 32. 33. 34. 35. 36. 37. 38. Service users live in a home which is run and managed by a person who is fit to be in charge, of good character and able to discharge his or her responsibilities fully. Service users benefit from the ethos, leadership and management approach of the home. The home is run in the best interests of service users. Service users are safeguarded by the accounting and financial procedures of the home. Service users’ financial interests are safeguarded. Staff are appropriately supervised. Service users’ rights and best interests are safeguarded by the home’s record keeping, policies and procedures. The health, safety and welfare of service users and staff are promoted and protected. The Commission considers Standards 31, 33, 35 and 38 the key standards to be inspected. JUDGEMENT – we looked at outcomes for the following standard(s): 31,33,35,38. Quality in this outcome area is good. This judgement has been made using available evidence including a visit to this service. The manager is qualified and has the necessary experience to run the home. Residents felt safe and secure. To improve communication staff are identifiable through wearing a badge. Residents’ finances are safeguarded by systems in the home. Health and safety issues are actively managed. EVIDENCE: The home manager has managed Rosemary Lodge for a number of years. She has recently completed the NVQ level 4. Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 21 A survey form reported that their relative “has been well supported during their stay at Rosemary Lodge and I have felt confident that they are safe and well cared for”. Another person stated “Rosemary Lodge is well run”. When asked do “they receive the care and support they need” ten people responded “always” (72 ) and four “usually” (28 ). The people who stated they usually receive the care they need, did so because they felt concern about time spent alone in the bedroom, that they should be more time to talk with their relative. A survey form returned from a GP sated that there is “good overall care of patients”. Improvements are being made in communication between the home and stakeholders. A relative group has been formed. Due to their condition many of the residents rely on their relatives or representatives to act as advocates. Representatives of the relatives group are able to meet with the Registered Persons for the home to discuss any issues. Staff were name badges. Relatives spoke of a red book for the exchange of information, a white board which helps the to see who is on duty. This makes sure that residents, relatives and other visitors to the home are able to address the correct people if they have any concerns. Residents’ finances are protected by the systems in use. Some residents have Guardians who look after their money, others have a small amount of money held by the home and a clear record was seen of transactions. Receipts are maintained for any purchases made on their behalf. Health and safety issue are dealt with by the home and statutory checks are carried out. Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 22 SCORING OF OUTCOMES This page summarises the assessment of the extent to which the National Minimum Standards for Care Homes for Older People have been met and uses the following scale. The scale ranges from: 4 Standard Exceeded 2 Standard Almost Met (Commendable) (Minor Shortfalls) 3 Standard Met 1 Standard Not Met (No Shortfalls) (Major Shortfalls) “X” in the standard met box denotes standard not assessed on this occasion “N/A” in the standard met box denotes standard not applicable CHOICE OF HOME Standard No Score 1 2 3 4 5 6 ENVIRONMENT Standard No Score 19 20 21 22 23 24 25 26 2 3 3 3 3 X HEALTH AND PERSONAL CARE Standard No Score 7 3 8 2 9 3 10 2 11 X DAILY LIFE AND SOCIAL ACTIVITIES Standard No Score 12 3 13 3 14 2 15 2 COMPLAINTS AND PROTECTION Standard No Score 16 3 17 X 18 3 3 x x x x x x 3 STAFFING Standard No Score 27 3 28 3 29 3 30 3 MANAGEMENT AND ADMINISTRATION Standard No 31 32 33 34 35 36 37 38 Score 3 x 3 x 3 X X 3 Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 23 Are there any outstanding requirements from the last inspection? yes STATUTORY REQUIREMENTS This section sets out the actions, which must be taken so that the registered person/s meets the Care Standards Act 2000, Care Homes Regulations 2001 and the National Minimum Standards. The Registered Provider(s) must comply with the given timescales. No. 1 Standard OP1 Regulation 4 (Schedule 1) 13(4)(c ) Requirement The home must have a clear Statement of Purpose setting out the aims and facilities provided by the home. The home must ensure a record is kept of manifestation of inappropriate behaviour and the interventions required to minimise this behaviour The home must ensure that the skin condition of residents is recorded accurately. Previous time scale of 30/05/07 & 30/4/07 was not met. The home must ensure that service users health care needs are met and fully recorded. The home must demonstrate that residents have choice and control over their lives concerning daily living. The home must review the manner of serving lunch and the deployment of staff in the second lounge. Timescale for action 30/09/07 2 OP8 31/08/07 3 OP8 13(4)(c) 31/08/07 4 4 OP8 OP14 13(4)(c) 12 31/08/07 30/09/07 5 OP15 12 30/09/07 Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 24 RECOMMENDATIONS These recommendations relate to National Minimum Standards and are seen as good practice for the Registered Provider/s to consider carrying out. No. 2 Refer to Standard OP3 Good Practice Recommendations All qualified staff should complete assessments. Rosemary Lodge DS0000019118.V341720.R01.S.doc Version 5.2 Page 25 Commission for Social Care Inspection SW London Area Office Ground Floor 41-47 Hartfield Road Wimbledon London SW19 3RG National Enquiry Line: Telephone: 0845 015 0120 or 0191 233 3323 Textphone: 0845 015 2255 or 0191 233 3588 Email: enquiries@csci.gsi.gov.uk Web: www.csci.org.uk © This report is copyright Commission for Social Care Inspection (CSCI) and may only be used in its entirety. 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